Adolescent substance abuse treatment programs lack key elements necessary for effective treatment

Sep 7 2004

Many highly regarded adolescent substance abuse treatment programs lack several key elements believed to be necessary for effective treatment, including strategies for engaging and retaining teens, showing gender and culture sensitivity, and evaluating the success of treatment, according to an article in the September issue of the Archives of Pediatrics & Adolescent Medicine.

According to information in the article, drug and alcohol abuse and dependence are the most common causes of adolescent illness and death in the United States, and effective treatment programs are urgently needed. "Only 10 percent of the estimated 1.4 million adolescents (aged 12 to 17 years) with an illicit drug problem are receiving treatment, compared with one in five adults," the article states. Adolescents have different needs than adults when it comes to drug treatment programs - adolescent drug users often have additional health problems, different developmental needs and are more likely to be binge drug users (as opposed to long-term, steady users).

Rosalind Brannigan, M.P.H., of Drug Strategies, Washington, D.C., and colleagues recruited an advisory panel of 22 experts to identify nine key elements of effective treatment for adolescent substance abuse. The panel also identified 144 highly regarded adolescent substance abuse treatment programs in the United States. Leaders of these programs were interviewed and surveyed regarding the nine key elements. There was a 100 percent response rate to the interviews, and a 65 percent response rate to the follow-up surveys. Programs were scored, with a possible total score of 45. The nine key elements included assessment at the beginning of the programs, treatment matching (providing tailored treatment for teens with psychiatric disorders, medical problems, etc.), qualified staff, competence in addressing gender and cultural differences, continuity of care, and evaluating the outcomes of treatment.

The researchers found that the average score for the treatment programs was 23.8, and programs that scored in the top quartile were not more likely to be accredited. Most programs scored at least a four out of five on only one of the nine key elements (qualified staff). The elements with the poorest scores were assessment and treatment matching, engaging and retaining teens in the program, gender and cultural competence, and evaluating treatment outcomes.

"Most of the 144 highly regarded programs we surveyed are not addressing the key elements of effective adolescent substance abuse treatment," the authors write. "More than 40 percent of the reviewed programs fulfilled fewer than half of the 45 components that make up the key elements, and only 3 percent of programs fulfilled four fifths of these components. However, high scores were achieved on individual key elements by several programs in our sample, suggesting that implementing the key elements in practice is already within reach of existing programs."

"Older programs appear to have higher quality scores," write the researchers. "However, few other program characteristics are associated with high quality."

http://archpedi.ama-assn.org/